{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T17:24:29Z","timestamp":1763400269064,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Pulmonary coinfection involving both viral and opportunistic pathogens is an emerging challenge in immunosuppressed patients. We report the case of a 59-year-old man with rheumatoid arthritis on long-term immunosuppressive therapy who developed necrotizing pneumonia and acute respiratory failure and was ultimately diagnosed with triple pulmonary coinfection by SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus. Diagnosis required comprehensive imaging, bronchoscopy with BAL, and microbiological work-up. The case was complicated by septic shock, multiple organ failure, and family-driven end-of-life decisions. This report highlights the diagnostic and therapeutic complexity of triple coinfection in the ICU, emphasizing the importance of systematic microbiology, imaging, and interdisciplinary care in critically ill immunocompromised hosts.<\/jats:p>","DOI":"10.3390\/life15091336","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T15:57:47Z","timestamp":1755878267000},"page":"1336","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Triple Pulmonary Coinfection with SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus Causing Necrotizing Pneumonia in an Immunomodulated Rheumatoid Arthritis Patient: Diagnostic and Therapeutic Insights"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8179-0486","authenticated-orcid":false,"given":"Wei-Hung","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8251-3808","authenticated-orcid":false,"given":"Ting-Yu","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan"},{"name":"Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Kuo","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e36692","DOI":"10.1097\/MD.0000000000036692","article-title":"Rare occurrence of pulmonary coinfection involving Aspergillus fumigatus and Nocardia cyriacigeorgica in immunocompetent patients based on NGS: A case report and literature review","volume":"102","author":"Ye","year":"2023","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e37073","DOI":"10.1097\/MD.0000000000037073","article-title":"Co-infection of Nocardia and Aspergillus fumigatus in an immunosuppressed patient","volume":"103","author":"Wang","year":"2024","journal-title":"Medicine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3201\/eid2704.204895","article-title":"COVID-19\u2013Associated Pulmonary Aspergillosis, March\u2013August 2020","volume":"27","author":"Sprute","year":"2021","journal-title":"Emerg. 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